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Objective:To explore the characteristics of weekly gestational weight gain (GWG) in women with obesity and its correlation with the risk of macrosomia.Methods:Clinical data of women with singleton pregnancy and pre-pregnancy body mass index (PPBMI) ≥28 kg/m 2 were retrospectively analyzed, from January 2014 to December 2019, in Beijing Obstetrics and Gynecology Hospital, Capital Medical University (Beijing Maternal and Child Health Care Hospital). The participants were divided into three groups based on their PPBMI: group A (28-<30 kg/m 2), group B (30-<32 kg/m 2), and group C (≥32 kg/m 2). The study compared the characteristics of GWG among the three groups, explored the correlation between the weekly weight gain during each gestational stage and the risk of macrosomia, and discussed the impacts of the GWG pattern in women with different PPBMI on the risk of macrosomia. Chi-square (or Fisher's exact), Kruskal-Wallis, and Mann-Whitney U tests were performed for statistical analysis. Multivariate logistic regression was used to analyze the impact of weekly weight gain in specific gestational stages on macrosomia. Results:(1) A total of 2 046 participants were included in the study, with 982 in group A, 588 in group B, and 476 in group C. For all of the 2 046 cases, the median PPBMI was 30.1 kg/m 2 (29.0-31.9 kg/m 2), GWG was 10.5 kg (7.3-14.0 kg), and neonatal birth weight was 3 520 g (3 215-3 816 g) with 60 (2.9%) ≥4 500 g, and the biggest baby weighed 5 580 g. Out of the births analyzed, macrosomia occurred in 318 cases (15.5%). (2) Among the three groups (A, B and C), the differences in maternal age [32.0 years (29.0-35.0 years), 32.0 years (29.0-35.0 years) and 32.0 years (29.0-34.0 years), H=6.58] and women with a history of type 2 diabetes mellitus [0.9% (9/982), 0.3% (2/588) and 1.9% (9/476), χ2=6.61] were statistically significant (all P<0.05). (3) The weekly weight gain in each group exhibited a gradual upward trend before 20-24 weeks, reached a plateau at 24-32 weeks, peaked at 32-36 weeks, and subsequently declined. The weekly weight gain of group A in the pre-pregnancy to 14 weeks [0.14 kg/week (0.00-0.25 kg/week)], 14 to 20 weeks [0.25 kg/week (0.17-0.42 kg/week)], and 20 to 24 weeks [0.38 kg/week (0.25-0.63 kg/week)] were higher than those of group B [0.07 kg/week (－0.03-0.21 kg/week), 0.25 kg/week (0.10-0.42 kg/week), and 0.38 kg/week (0.22-0.60 kg/week)], respectively ( Z value was－3.73,－2.16, and－2.01, all P<0.05). Likewise, the weekly weight gain of group B in the above three stages were all higher than those of group C [0.07 kg/week (－0.10-0.21 kg/week), 0.17 kg/week (0.05-0.33 kg/week), and 0.25 kg/week (0.08-0.50 kg/week)], respectively ( Z value was－2.55,－3.28, and－3.25, all P<0.05). (4) The risk of macrosomia increased with the weekly weight gain in specific gestational stages in different PPBMI groups. In group A, the stages correlated with increased risk were 14-20 weeks [adjusted odd ratio ( aOR)=2.669, 95% CI: 1.378-5.169] and 20-24 weeks ( aOR=1.764, 95% CI: 1.143-2.723), while the stages were 20-24 weeks ( aOR=2.149, 95% CI: 1.156-3.996) and 36 weeks until delivery ( aOR=1.888, 95% CI: 1.268-2.810) in group B, and pre-pregnancy to 14 weeks ( aOR=3.515, 95% CI: 1.158-10.665) and 14-20 weeks ( aOR=3.021, 95% CI: 1.058-8.628) in group C (all P<0.05). The risk of macrosomia increased when the weekly weight gain of both risk-related stages in group A ( aOR=2.255, 95% CI: 1.029-4.940) ≥50th percentile, and group B ( aOR=4.399, 95% CI: 1.017-19.023) ≥75th percentile, and for group C ( aOR=3.404, 95% CI: 1.004-11.543) when the weekly weight gain above 25th percentile (all P<0.05). Conclusions:Weekly GWG demonstrates an observable gradual acceleration pattern in women with obesity. Therefore, clinical attention should be directed towards monitoring fluctuations in the weekly weight gain in this population, as excessive weekly weight gain before 24 gestational weeks is associated with an elevated risk of macrosomia.
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Objective:To analyze the maternal gestational weight gain (GWG) in women with pre-pregnancy obesity and its relationships with adverse pregnancy outcomes.Methods:This retrospective cohort study recruited 513 obese women (pre-pregnancy body mass index ≥30 kg/m 2) with singleton pregnancy in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2014 to December 2016. All participants were divided into three groups according to GWG: inadequate (GWG<5 kg, n=83), adequate (5 kg≤GWG≤9 kg, n=154), and excessive (GWG>9 kg, n=276) groups. Chi-square test, Fisher's exact test, Kruskal-Wallis test, and Mann-Whitney U test were used to compare the clinical data among the three groups, including GWG, pregnancy and neonatal outcomes, and labor process. Multivariate logistic regression was performed to analyze the association between maternal GWG and main pregnancy complications associated with obesity. Results:(1) Among 238 participants who gained more than 2.0 kg in the first trimester, 75.6% (180/238) were in the excessive group, while the rate was 34.9%(96/275) among the participants who gained less than 2.0 kg. (2) Postpartum body mass index retention (body mass index at six weeks postpartum minus pre-pregnancy body mass index) was the highest in the excessive group, followed by the adequate group and the inadequate group [0.8 kg/m 2 (0.0-2.2 kg/m 2) vs -0.7 kg/m 2 (-1.6 to 0.0 kg/m 2) vs -2.5 kg/m 2 (-3.2 to -1.5 kg/m 2), all P<0.05]. (3) The rates of primary cesarean section in the inadequate and adequate groups were 29.9% (20/67) and 32.6% (42/129), which were lower than that in the excessive group [43.3% (104/240), χ2=3.955 and 4.047, both P<0.05]. There were no statistically significant differences in the incidence of gestational hypertension, small/large for gestational age, or other major adverse pregnancy outcomes among the three groups (all P>0.05). The weight gain in the first trimester and before the oral glucose tolerance test were not correlated with gestational diabetes mellitus (GDM) ( aOR=1.038, 95% CI: 0.986-1.094, P=0.157; aOR=1.055, 95% CI: 1.000-1.113, P=0.051). The maternal weight gain of women with GDM during the 2nd, the 3rd, and the whole trimesters were lower than women without GDM respectively [3.0 kg (1.3-4.0 kg) vs 3.0 kg (2.0-5.0 kg), 4.0 kg (2.0-6.0 kg) vs 6.0 kg (4.0-8.0 kg), 9.0 kg (5.0-12.0 kg) vs 10.7 kg (7.5-15.0 kg); Z =-2.938, -6.352 and-4.104, all P<0.01]. Conclusions:In women with pre-pregnancy obesity, the first trimester is the critical window to control maternal GWG. GWG guidelines recommended by the Institute of Medicine could help to reduce the weight retention at six weeks postpartum, but couldn't reduce the risk of GDM, gestational hypertension, small/large for gestational age, or other major adverse pregnancy outcomes.
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Objective@#There is no effective therapy for patients with advanced medullary thyroid carcinoma (MTC). Vandetanib,a novel multitargeted receptor tyrosine kinase inhibitor, has previously shown antitumor activity in phase Ⅱ studies of patients with advanced MTC. This study was to evaluate the efficacy and the safety of vandetanib on advanced MTC.@*Methods@#This study was an open, international multi-center phase Ⅲ clinical trial and the study number was NCT01298323. The single-center study was a sub-group analysis of the international study, which was conducted on 9 pathologically confirmed advanced MTC patients by Cancer Hospital Chinese Academy of Medical Sciences between March 2012 and October 2017. Vandetanib (300 mg) was orally administered daily till death or withdrawal. The efficacy was evaluated according to RECIST criteria and the adverse events were evaluated according to NCI criteria.@*Results@#The objective response rate was 3/9,and the disease control rate was 4/9. The median progression-free survival was 44 months. All patients who had the elevated levels of calcitonin (CTN) and carcino-embryonic antigen (CEA) before treatment began to show the decreases in the level of CTN and CEA after 3 months and later showed again the increases in the levels of both tumor markers with tumor progression. By ROC curve analysis, CTN was of statistically significance(P<0.05, 95%CI 0.558-0.834), but CEA was not(P>0.05). Adverse events were generally mild (grade 1 or 2),including hypertension (9 cases),skin rash (9 cases), and diarrhea (6 cases). Two patients developed grade 3 elevation of serum glutamate pyruvate transaminase and one patient developed grade 3 elevation of drug-related bowel disease. No grade 4 drug-related adverse event occurred.@*Conclusions@#Vandetanib is effective and well tolerated for patients with locally advanced or metastatic MTC who have no chance for surgery. This indicates the increase of CTN is clinically relevant to disease progression, but the number of patients are extremely low, and, therefore further research is needed. Long-term use of vandetanib may cause resistance.
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<p><b>OBJECTIVE</b>To explore the genetic basis for fetuses with cleft lip and palate.</p><p><b>METHODS</b>For 100 fetuses diagnosed with cleft lip with or without palate, G-banding chromosomal karyotyping and copy number variation sequencing (CNV-seq) were carried out on chorionic villi, amniotic fluid or cordocentesis samples.</p><p><b>RESULTS</b>No genomic abnormality was found among 49 fetuses with isolated cleft lip and palate, while 12 genomic aberrations were found among 51 fetuses with syndromic cleft lip and palate, which included 4 cases with trisomy 13, 2 cases with trisomy 18, 1 with X chromosome aneuploidy, 2 with other chromosomal aneuploidies and 3 with pathogenic CNVs.</p><p><b>CONCLUSION</b>The incidence of genomic abnormalities in fetuses with cleft lip and palate was high. In addition to chromosomal abnormalities, attention should also be paid to pathogenic CNVs.</p>
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BACKGROUND: Short dental implants have been widely used in the posterior area when one tooth loses. How effective is it when we use the short implants in the rigid fixed bridge for the multiple teeth lost area?OBJECTIVE: To observe the clinical effect of short dental implants used in the rigid fixed bridge.METHODS: Forty-three patients with multiple missing teeth were enrolled and underwent the rigid fixed bridge supported by short dental implants, including 26 males and 17 females, with an age range of 44-67 years. After 2 years of dental implantation, the success rate of dental implants, amount of alveolar bone loss and dental implant-related complication were followed up.RESULTS AND CONCLUSION: A total of 92 short dental implants, 6-8 mm in length, were implanted,including 44 in the maxilla and 48 in the mandible. There were two cases of peri-implantitis and the success rate of implants was 97.8%. There was no significant difference in the amount of alveolar bone loss between the 8 mm, 7 mm and 6 mm length implants as well as between the C/I ≤ 1, 1 2 groups at 1-2 years after implantation. There were four cases of central screw loose and one case of porcelain fracture after restoration. To conclude, the clinical use of short dental implants in the rigid fixed bridge has achieved good outcomes during the short period, but long-term observation is needed.
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BACKGROUND:Submerged dental implants that are completely embedded into soft tissues and isolated from the oral environment reduce the potential for infection factors, and are not influenced by the bite force, to ensure the implant osseointegration. OBJECTIVE:To compare the effects of submerged and non-submerged dental implants on the recovery of oral soft tissues. METHODS:Twenty-four patients who had no contraindication of dental implants and missed one molar with the gingival thickness of more than 1.5 mm were enrol ed and divided into two groups. Patients were implanted with non-submerged SS implants of OSSTEM in one group (non-submerged group) and implanted with submerged TS implants of OSSTEM in the other group (submerged group). Variation of gingival thickness, Jemt index and alveolar bone resorption were detected after 2 weeks of one-and two-stage surgery and 1 year after surgery. RESULTS AND CONCLUSION:There were no statistical differences in gingival thickness, Jemt index and alveolar bone resorption between two groups. As these two surgical methods have no difference, we would like to use submerged or non-submerged implants in the patients with corresponding indications.
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Objective To evaluate the guidance value of VKORC1 and CYP2C9 gene polymorphism on clinical application of warfarin in patients with non-valvular atrial fibrillation (NVAF). Methods A total of 290 cases of patients with NVAF were identified and their baseline data , initial dose of warfarin and base INR measurement results were recorded, then the follow-up was conducted. The initial administration of warfarin to INR standard time for the first time, total amount of warfarin and the average daily amount were recorded. All participants′ venous blood was extracted for VKORC1 and CYP2C9 gene polymorphism test. Results VKORC1 AG/GG genotype patients had longer INR standard time and higer amount of warfarin than patients with AA (103.38 ± 65.29)g vs. (53.26 ± 24.02)g, P < 0.05. Patients with type CYP2C9 gene mutation had shortest INR standard time(9.10 ± 2.01)d vs. (13.07 ± 4.28)d, P < 0.05. and lowest administration amount of warfarin (28.80 ± 17.35)g vs. (55.45 ± 23.67)g, P < 0.05. Conclusion There exist significant differences of first adminstration amount of warfarin in patients with NVAF to INR standards. Warfarin dose for VKORC1 AA genotype patients is lower than that for GG/AG type; there is short INR standard time and less adminstration amount of warfarin for CYP2C9 genotypes AC/CC patients.
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Objective To evaluate the efficacy of light-emitting diode (LED) irradiation at 530 nm,630 nm and 850 nm in the treatment of photoaged skin.Methods A total of 14 adults with photoaged extensor forearm were recruited in this study.Three areas were selected at the extensor forearm in each of these subjects and received LED irradiation at 530 nm,630 nm and 850 nm,respectively,thrice a week for 12 sessions.Dermoscopy was used to visualize these areas before and after the irradiation,the Corueometer CM 825 to measure stratum corneum (SC) hydration,Tewameter TM 300 to determine transepidermal water loss (TEWL),and CM-2600d spectrophotometer to measure L* value and melanin index (MI).Tissue specimens were obtained from these areas irradiated with LED at 530 nm (n =5),630 nm (n =5) and 850 nm (n =4) separately before and 6 weeks after the initial irradiation,and subjected to histopathological examination.Results Both skin texture and pigmentation were improved in 10 and 7 testees after 12 sessions of LED irradiation at 630 nm and 850 nm,respectively,but the skin texture became rougher and pigmentation was increased in 7 testees after LED irradiation at 530 nm.After LED irradiation at 630 nm and 850 nm,the testees experienced an obvious increase in SC hydration ((37.9 ± 7.7) au and (34.5 ± 7.1) au at 6 weeks after the initial irradiation vs.(33.1 ± 6.1) au and (32.0 ± 7.0) au before irradiation,both P ＜ 0.05),but a significant decrease in TEWL value ((9.8-± 2.5) and (10.9 ± 2.5) g·m-2·h-1 at 6 weeks after the initial irradiation vs.(14.0 ± 1.8) and (14.2 ± 2.6) g·m-2·h-1 before irradiation),with no significant changes in L* value or MI (both P ＞ 0.05).No evident alteration was observed in SC hydration or TEWL value (both P ＞ 0.05),while the L* value significantly decreased (P ＜ 0.05) and MI increased (P ＜ 0.05) after LED irradiation at 530 nm.Histopathological examination showed photo-induced denaturation of collagen fibers and elastic fibers in the dermis of these subjects before irradiation,as well as nascent collagen fibers and elastic fibers in a more dense and regular arrangement after irradiation at the three wavelengths.Conclusions LED irradiation at both 630 nm and 850 nm can improve the appearance and barrier function of,and stimulate the proliferation and rearrangement of collagen fibers and elastic fibers in,photoaged skin,while LED irradiation at 530 nm increases skin pigmentation.
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Objective To ensure the quality of live attenuated measles vaccine on the market,viral titers were determined as the market surveillance test.Methods The measles vaccine was sampled from sites located in 24 provinces (cities,autonomous regions) of China,including provincial CDC,municipal CDC,county CDC,and primary users.The virus titer of samples was tested to evaluate the quality status of measles vaccine on the market.Results For all the 54 lots of measles vaccine sampled in this study,the virus titers were in compliance with the requirements of the China Pharmacopeia Vol.III (2005 edition).In comparison with the original test results provided by the manufacturers,the mean virus titer was decreased 0.2 lg?0.3.Conclusion Viral titers of measles vaccine batches sampled from the market were all in compliance with the requirements of the China Pharmacopeia Vol.III (2005 edition).It showed that the measles vaccine in China market has good stability,and the cold chain system for measles vaccine conveyance and storage could ensure the vaccine efficacy.
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Objective To explore the feasibility and advantage of the small figure-L unilateral transternal incision for the treatment of anteri or mediastinal tumor. Methods Twenty-four patients with anteri or mediastinal tumor were enrolled in the study. Under general anesthesia, after a 6 to 10 cm midline skin incision was made, a unilateral figure-L partial ste rnotomy on the side occupied by the tumor was made in the second or third interc ostals space, taking into account the tumor size and location. Tumors were resec ted with excellent exposure. Results All tumors were completely resected during the operation. In 8 cases, tumors encroached on the adjacent lu ng tissue, and lung tissue was partially resected. In 6 cases, tumors invaded th e pericardium, and the pericardium was partially removed. Mean operating time wa s 106 minutes (80~125 minutes). The mean time of hospital stay was 5 days after the operation, and there was no complication. All patients were alive with a mea n follow-up period of 14 months (3~24 months). Conclusion The figure-L unilateral mini-sternotomy is considered as an effective and useful mi nimally invasive approach for anterior mediastinal tumors.
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Objective To study the feasibility of video-assisted thoracoscopic (VAT) minor pulmonary resection under local anesthesia. Methods From February to December 2000,8 patients (6 cases of peripheral pulmonary nodules,2 cases of respiratory insufficiency and radiographic pulmonary infiltrate)were operated on through video-assisted thoracoscopy under local anesthesia. Results Except 1 case was converted to general anesthesia and performed minithoracotomy to resect pulmonary coin lesion due to pleural adhesion,other 7 patients underwent VAT-pulmonary wedge ressction under local anesthesia and definitive diagonosis.(3 with tuberculosis,1 with metastatic adenocarcinoma,1 with inflammatory pseudotumor and 2 with pulmonary fibrosis)were obtained.The duration of the procedures was from 40 to 200 min. Spontaneous breathing and hemodynamics were maintained well during the operation.There was neither severe postoperative complications nor mortality.The postoperative hospitalized days were 2～5 days with a mean of 3 days. The average medical fee for pulmonary wedge ressction using our procedure was 5400 RMB. Conclusions VAT-minor pulmonary resection can be performed safely under local anesthesia.